Gotham Gazette

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Winning the Public Health Recovery from Covid

Mayor Adams visits health care workers (photo: Michael Appleton/Mayoral Photography Office)

In its battle against COVID-19, New York City, even under a notably disorganized mayor, arrived at an impressive level of health organization. As may be recalled, Mayor de Blasio switched the lead role in the covid fight to Health + Hospitals, the city’s public hospital system, from the Department of Health and Mental Hygiene (DOHMH), which retained major responsibilities but not its usual lead position in epidemics. It is to the credit of both agencies that, under this forced and rather resented bureaucratic marriage, they managed to develop a level of cooperation that saw the city, for one thing, consistently attain the highest COVID-19 testing rate of any large U.S. city.

 But, beyond that, something else happened. For the first time, the city funded an extensive network of community organizations coordinated in a singular mission — fighting a horrible infectious epidemic. Outreach workers and health educators from these organizations were constantly in the streets when almost no one else would be, promoting COVID-19 testing, prevention, masks, proper quarantine, and, of course, vaccination.

 The community-based organizations (CBOs) also formed a Community Advisory Board providing constant insight to refine city covid programming. Today in New York City, which had the nation’s highest COVID-19 death rate in the first surge, 87% of adults have received at least one vaccination shot, with 78% fully vaccinated, the highest rate of any big U.S. city.

 It is time to use this unprecedented health infrastructure to immediately address our other health crises, especially diabetes and the chronic diseases that fuel both COVID-19 and the city’s disturbing levels of preventable ill health.

 New York City is very, very sick.

Between chronic disease, uncountable cases of long covid, and the increasing evidence that those who had covid are at elevated risk for diabetes, the city faces staggering levels of illness. To forestall this disaster, New York must widely assure that thousands of people in neighborhoods overwhelmed by chronic diseases directly learn chronic disease prevention and self-care. With its COVID-19 infrastructure, the city absolutely already has the necessary vehicle to move forward. The neighborhoods and the Black, Latino, and low-income populations most devastated by COVID-19 are, tragically, the neighborhoods also most devastated by chronic disease.

 Yet, the city seems to be letting its COVID-19 infrastructure collapse. Instead of starting to deliver proven health-building services, the first group of some 35 CBOs that the city partnered with to fight covid will be defunded by the city in a few months. In losing these CBOs, the city loses their neighborhood staffs of community health workers, outreach teams, and peer educators — people uniquely able to engage very distressed communities in trying to rebuild health.

For an example of the kind of effective health education these groups could provide, consider the following. A few years ago, with special federal funding, Health People instituted a four-week training course to prepare local Bronx people with diabetes and pre-diabetes to deliver the Diabetes Self-Management Program (DSMP). This six-session course reduces blood sugar -- immediately reducing vulnerability to the worst covid outcomes -- as well as overall complications, and the high rates of co-morbid depression seen in diabetes. It also slashes emergency room visits by 40% or more -- an extraordinary benefit.

The peer educators fanned out to dozens of community sites -- churches, homeless shelters, mental health programs, public housing -- and enrolled almost 2,000 Medicaid recipients with Type 2 diabetes in the DSMP. This was evidently the largest community mobilization for diabetes self-management ever to occur in the United States. And it was defunded just as covid struck and preyed upon those with underlying chronic conditions.

By contrast to its impressive fight against covid, the city has long failed to make any credible effort to control chronic disease. In a city that had a staggering 356% increase in diabetes deaths in the first covid surge, DOHMH doesn’t now -- and never has -- supported a single DSMP group where those with Type 2 diabetes could learn better self-management.

And it’s not just specific diseases. For example, with that same now-ended federal funding, Public Health Solutions worked with NYC Health + Hospitals to form community networks that included 275 diverse community-based partners, which helped 16,000 H+H patients, mainly those just discharged, linking them to vital services -- such as programs to provide nutritious food. This generated approximately $1.4 million in health-care savings through the improved well-being even of very sick people.

If DOHMH and H+H don’t use their large shares of the city’s billions in federal emergency funds to support and coordinate the many health-building services that the CBOs who worked on covid can so clearly provide, New York will have largely won the fight against COVID-19 only to totally and tragically lose the recovery.

Chris Norwood is Executive Director of Health People. Lisa David is President of Public Health Solutions. On Twitter @HealthPeopleOrg & @wearephsny.

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